HSV-1 vs. HSV-2: What's the Difference?

There’s a lot of stigma attached to herpes, but what most people don’t know is that herpes affects more than half of the global adult population. 

There are several types of herpes, including herpes zoster (known as shingles), herpes simplex virus type (HSV-1) and herpes simplex virus type 2 (HSV-2). 

When people talk about herpes, they usually mean HSV-1 or HSV-2. Of these two types of herpes, HSV-1 is the most common, affecting about 67 percent of people under 50 — about 3.7 billion people worldwide. HSV-2 affects about 491 million people aged 15–49 (13 percent of that age group). 

But other than prevalence, what is the difference between herpes 1 and 2? 

For one, while HSV-1 mostly causes oral herpes (cold sores), whereas HSV-2 mostly causes genital herpes. As for things they have in common, both of these viruses can cause both oral and genital herpes, and both are also lifelong — meaning that there is no cure.

The good news? Some research shows that HSV-2 infections are decreasing among some populations in the United States.

Even more good news is that, although herpes can’t be cured, the symptoms can be treated with prescription meds and over-the-counter treatments to soothe your discomfort and to reduce or prevent recurrent symptoms.  

Let’s talk about the difference between herpes 1 and 2, the symptoms of both and your treatment options.

The symptoms of HSV-1 and HSV-2 are similar.  Flu-like symptoms typically occur the first time a person is infected, and sores appear on the skin during both initial infections and future symptomatic episodes. These symptoms may appear for a few days and then clear up, only to reoccur later.

The main difference between herpes 1 and 2 is the part of the body that each affects more commonly. While HSV-1 typically affects the mouth and lips, HSV-2 more commonly affects the genitals. That said, according to the Centers for Disease Control and Prevention (CDC), an increasing number of genital herpes cases are now caused by HSV-1, most often spread through oral sex.

HSV-2 is considered a sexually transmitted infection (STI) but can also be transmitted through skin-to-skin contact. Oral herpes (HSV-1) is similar and can be transmitted both sexually and through skin-to-skin contact like kissing or sharing a cup

The majority of people with herpes types 1 and 2 are asymptomatic. This means you might have herpes without knowing it.

Symptoms of HSV-1 

The symptoms of HSV-1 are usually most severe during the first outbreak.

You might experience flu-like symptoms, such as:

• Chills 

• Fever

• Headache

• Muscle aches and pains

• Swollen lymph nodes in your throat, underarms or groin

• Tiredness

However, the main symptom of HSV-1 is cold sores, also called fever blisters. These are small, fluid-filled blisters or ulcers that occur around the mouth and lips, as well as inside your mouth. These lesions may be painful and itchy. They usually ooze fluid and then form a crust.

HSV-1 can also affect other parts of your body, including your genital area and eyes. 

An HSV-1 infection in the eyes can cause:

• Blurry vision 

• Pain

• Redness or discoloration

• Tearing

• Light sensitivity

If you think you have a herpes infection in your eye, it’s important to get immediate medical help, as it can affect your vision.

Symptoms of HSV-2

As with HSV-1, HSV-2 symptoms are usually the most intense the first time you have an outbreak. You might experience flu-like symptoms during each HSV-2 outbreak. 

HSV-2 can cause a genital herpes infection. This causes small lesions, or sores, to appear on your genital area. Painful urination is a possible genital herpes symptom, as the sores can sometimes affect the urinary tract.

Although herpes sores vary in how they look and feel, they may be:  

• Itchy or tingly

• Painful 

• Oozing

• Red or white

They can show up anywhere around your genital area, sometimes also affecting the anus, rectum, upper thighs and buttocks.  HSV-2 can also affect other parts of your body, including your lips, other parts of your mouth, and eyes. 

There are three main stages or phases of herpes:

• Latent. During the latent phase, the virus is dormant (inactive). You won’t experience any symptoms, but your body still carries the herpes virus. 

• Shedding. When the virus is shedding, it’s possible to transmit it to other people even if you don’t have symptoms. 

• Prodrome. Also called the outbreak phase, this is when the virus reactivates and causes symptoms again. Stress, illness and hormonal changes can all trigger a recurrence.

During a herpes outbreak, the blisters go through several phases:

• Tingling, where you’ll experience tingling or itching at the site of the blister

• Formation of the blisters 

• Oozing, when the blisters may break open and leak fluid

• Crusting over the blisters

• Healing

It’s a good idea to learn the early warning signs of a herpes outbreak. If you know what’s coming, you might be able to treat or even stop a cold sore in the early stages. This can help you cut down on the time it takes to heal.

The HSV viruses can be transmitted from person to person through oral-to-oral contact, oral-to-genital contact, or genital-to-genital contact. 

HSV-1 is most commonly transmitted from oral contact that includes kissing or sharing utensils, lip balm, or a drink. HSV-1 or HSV-2 transmission through oral-to-genital contact can happen during oral sex. This is the most common way that an HSV-1 oral infection in one person can become an HSV-1 genital infection in someone else .HSV-2 spreads mostly through sexual contact, including vaginal and anal sex.

There’s a widespread myth that you can only transmit herpes when you’re currently having an outbreak. Although it’s a good idea to take extra precautions during a herpes outbreak, it’s entirely possible to spread the virus even when you’re asymptomatic.

In other words, you may give HSV to your partner without even knowing you have it. 

We don’t say this to make you panic, but to emphasize the importance of STI testing — and to highlight that your partner getting a herpes infection isn’t necessarily a sign that they’re cheating on you. Because so many of us have asymptomatic herpes, it’s possible that one or both of you have had the condition for years. 

So rather than making any accusations, prioritize getting tested for herpes and getting the right treatment ASAP. 

A healthcare professional might be able to diagnose herpes simply by looking at your blisters (a visual examination) and asking about your symptoms.

But sometimes, they’ll need to run tests. This may be especially necessary if it’s difficult to determine whether your lesions are caused by herpes or another condition, like a different STI.

Your healthcare provider can confirm the diagnosis through a lab test called a viral culture. This involves taking a skin sample or swab of your lesions. Ideally, they want to take this sample at the height of your outbreak, because that’s when the test will be most accurate.

If you’re not currently experiencing an outbreak, a healthcare practitioner might run blood tests instead. These tests check for HSV antibodies, which your body makes in response to a herpes infection. Antibody tests will show if you have ever been exposed to HSV-1 or HSV-2, but they are not enough to diagnose an active HSV-1 or HSV-2 infection

It’s tempting to say that herpes is no big deal, especially since most of us have the virus. 

Unfortunately, that’s not the case for everybody. For some people, herpes can be quite dangerous. The virus can lead to further health issues, especially for people who are immunocompromised, meaning their immune system doesn’t function well.

These complications include:

• Higher risk of getting HIV. Having genital herpes can increase your risk of getting HIV through sexual contact, according to the World Health Organization. 

• Meningoencephalitis (brain infection). While very rare, it’s possible for HSV to affect the brain, especially if you have low immune function.

• Eye infections. The virus can spread to your eye, causing vision issues. 

• Neonatal herpes. During childbirth, a baby may be exposed to HSV. This is rare, but it can cause a neurological disability. In some cases, neonatal herpes can be fatal. This is why herpes testing is especially important for pregnant women.

Another potential herpes complication? Your mental health. Sadly, we still live in a world where STIs are met with stigma — even super-common conditions like herpes. If you’re struggling with feelings of shame or isolation, don’t hesitate to reach out for mental health help. 

Because herpes can be dangerous, it’s a good idea to speak with a healthcare practitioner if you have (or think you have) an infection. 

So here’s the good news: although herpes can’t be cured, it can be treated. 

One of the most common herpes treatments is valacyclovir. It’s an antiviral medication also known by the brand name Valtrex®.

Research shows that valacyclovir can treat HSV-1 and HSV-2 infections. One review found that valacyclovir therapy at the first sign of cold sores can help your lesions heal faster. A review also found that valacyclovir could also reduce the risk of transmitting herpes to one’s sexual partner.

Other herpes treatments include Zovirax® (acyclovir) and Famvir® (famciclovir), both of which are antiviral medications.

Daily use of antiviral medication is also most effective in preventing future outbreaks and reducing the risk of further infection.

While these herpes treatments can speed up the healing process, the symptoms of herpes can still be really uncomfortable — and in some cases, downright painful. 

You can manage the symptoms of cold sores by:

• Avoiding acidic food, as it can sting

• Using over-the-counter pain medications

• Drinking cold drinks or sucking on ice blocks or popsicles

If you have genital herpes, you can:

• Sit in a warm bath for 20 minutes to soothe pain

• Wear loose-fitting underwear where possible

• Use over-the-counter pain medicines

Prevention is an important part of the conversation too. In addition to managing your own symptoms, you’ll want to avoid transmitting HSV to others — especially if they’re immunocompromised. 

You can prevent transmitting herpes by:

• Not having sex during an active outbreak. Although you can still have sex with herpes, you’re most likely to transmit herpes during an outbreak. However, even if you’re asymptomatic, you can still pass it to others.

• Using barriers, like dental dams or condoms, during sexual activity. Although you can spread HSV while using a condom, it reduces the chances of transmission.

• Avoid sharing mouth stuff. HSV-1 can spread if you share utensils, drinks, lip balm, straws or face towels with others, especially if you’re experiencing an outbreak.

• Being mindful about skin-to-skin contact during an HSV-1 infection outbreak. It’s best to avoid kissing someone on the lips or face, especially if you have open lesions.

• Wash your hands thoroughly after touching any lesions, especially open sores.

Even if you take all of the above precautions, there’s still a risk of infecting someone with herpes — especially during sexual contact.

It’s essential to have that conversation with your sexual partners, pre-sex, so that they’re aware of the potential risk. This is especially important if they’re immunocompromised or pregnant.

Although HSV-1 is more prevalent than HSV-2, these two types of herpes are both very common. Both herpes viruses remain in your body for life, and there is no cure. However, the symptoms can be managed. 

Here are the main similarities and differences between the two types:

• Both can cause genital herpes. The main difference between herpes 1 and 2 is that HSV-1 usually causes oral herpes, while HSV-2 is more commonly associated with genital herpes.

• The symptoms of both herpes simplex viruses are similar. Both conditions cause flu-like symptoms and lesions. Plus, both can be asymptomatic — many people have herpes without realizing it. 

• Neither type of herpes can be cured. HSV-1 and HSV-2 are both lifelong conditions, but the symptoms can be managed through prescription drugs and over-the-counter medication.

Another similarity between the two? Both can be pretty dangerous if you’re immunocompromised. So if you think you have herpes, it’s best to head over to your GP or another healthcare practitioner. They can advise you on treatments for herpes to ease your symptoms. 

Ready to take charge of your sexual health? If you need expert advice, we can help you connect with a healthcare practitioner. Together, you can explore treatment options to manage your symptoms.